This is a case report of metformin-induced hepatotoxicity. As the prevalence of type 2 diabetes and subsequent metabolic effects increases in the US, metformin use will likewise increase. As potential for increased idiosyncratic hepatotoxicity associated with metformin use is likely to occur, clinicians should be vigilant.

Objective. To implement and assess the effectiveness of an activity to teach pharmacy students to critically evaluate clinical literature using instructional scaffolding and a Clinical Trial Evaluation Rubric. Design. The literature evaluation activity centered on a single clinical research article and involved individual, small group, and large group instruction, with carefully structured, evidence-based scaffolds and support materials centered around 3 educational themes: (1) the reader's awareness of text organization, (2) contextual/background information and vocabulary, and (3) questioning, prompting, and selfmonitoring (metacognition). Assessment. Students initially read the article, scored it using the rubric, and wrote an evaluation. Students then worked individually using a worksheet to identify and define 4 to 5 vocabulary/concept knowledge gaps. They then worked in small groups and as a class to further improve their skills. Finally, they assessed the same article using the rubric and writing a second evaluation. Students' rubric scores for the article decreased significantly from a mean pre-activity score of 76.7% to a post-activity score of 61.7%, indicating that their skills in identifying weaknesses in the article's study design had improved. Conclusion. Use of instructional scaffolding in the form of vocabulary supports and the Clinical Trial Evaluation Rubric improved students' ability to critically evaluate a clinical study compared to lecturebased coursework alone.

Objective. The Health Sciences Reasoning Test (HSRT) is a validated instrument to assess criticalthinking skills. The objective of this study was to determine if HSRT results improved in second-year student pharmacists after exposure to an explicit curriculum designed to develop critical-thinking skills. Methods. In December 2012, the HSRT was administered to students who were in their first year of pharmacy school. Starting in August 2013, students attended a 16-week laboratory curriculum using simulation, formative feedback, and clinical reasoning to teach critical-thinking skills. Following completion of this course, the HSRT was readministered to the same cohort of students.Results. All students enrolled in the course (83) took the HSRT, and following exclusion criteria, 90% of the scores were included in the statistical analysis. Exclusion criteria included students who did not finish more than 60% of the questions or who took less than 15 minutes to complete the test. Significant changes in the HSRT occurred in overall scores and in the subdomains of deduction, evaluation, and inference after students completed the critical-thinking curriculum. Conclusions. Significant improvement in HSRT scores occurred following student immersion in an explicit critical-thinking curriculum. The HSRT was useful in detecting these changes, showing that critical-thinking skills can be learned and then assessed over a relatively short period using a standardized, validated assessment tool like the HSRT.

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BackgroundRoseman University of Health Sciences (RUHS) developed and delivers a mastery learning curriculum designed for students to acquire the knowledge and skills to become competent nurses. Despite a trend in nursing education to adopt competency-based education (CBE) models, there is little in the nursing literature about programs based on a mastery model. The aim of this study is to describe an undergraduate nursing program built on a mastery learning model and to report on program outcome measures.MethodsThe 18-month BSN nursing program is divided into blocks, varying in length and focusing on a single subject. Students must demonstrate mastery, defined as ≥90% on an assessment, to pass a block. Recognizing the critical nature of health care, educators seek methods to assure that practitioners become competent to perform the services they provide.Program outcomes reported include comparisons to national standards and RUHS student exit survey data.ResultsFrom 2013 to 2017 the RUHS College of Nursing students’ pass rates ranged from 82 to 97% for the National Council Licensure Examination exam compared to national pass rates between 81.8–84.5% during the same time frame. The program completion rate ranged from 86 to 100% and employment rates exceeded accreditation standards. Students reported overall satisfaction with their education as 4.38 and with the block system as 4.74 (5 point Likert scale).ConclusionsRoseman University’s mastery learning model appears successful as measured by high levels of student satisfaction, outcomes on exams, and degree completion when compared to national averages. The results suggest that other nursing and health profession’s programs can develop a successful mastery based learning model.

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Objective. To determine whether instructor-prepared classroom examinations for pharmacotherapy courses were aligned with course goals and objectives. Design. Assessment items from examinations in 2 pharmacotherapy courses were evaluated. Four categories of alignment (depth of knowledge, categorical concurrence, range of knowledge, and balance of representation) were used to match course assessments with objectives. Assessment. While assessments met the criteria for acceptable alignment, there were areas for improvement. Goals and objectives were unevenly assessed, with 1 goal aligning with 45% of all assessment items. The assessments covered all content categories and the range of knowledge established by the objectives, but objectives under specific goals were not evenly assessed. Conclusion. This alignment study provided quantitative data useful for review and revision of pharmacotherapy course objectives and assessments and demonstrated the usefulness of alignment assessment as a tool for continuous quality improvement.Keywords: alignment, assessment, curriculum objectives, pharmacotherapy INTRODUCTIONEffective educational outcomes require the coordination of curriculum, instruction, and assessment. One measure of educational outcomes is alignment, or the matching of test content to subject area content. Alignment is defined as ''. . .the degree to which expectations and assessments are in agreement and serve in conjunction with one another to guide the system toward students learning what they are expected to know and do. '' 1 Using this definition, the ''expectations'' within a higher education course become the course goals and objectives; the corresponding assessments are the examinations.In an aligned system, all parts of the system work together to guide instruction and facilitate student learning. 2Learning expectations and classroom assessments cover the same content and assessments accurately measure the students' knowledge across the depth and breadth of the goals and objectives. An analysis of alignment provides evidence of assessment content validity, identifies needs for improvement, and contributes to instructional accountability.The University of New Mexico College of Pharmacy Curriculum Committee monitors the development and delivery of the curriculum as part of an ongoing commitment to continuous quality improvement. Course goals and objectives are mapped to the expected competencies and outcomes. Instruction is audited for content and delivery methods. Written classroom assessments undergo test-item analysis. However, no work has been conducted to determine whether the written classroom examinations are aligned with the course goals and objectives.There are 3 major approaches to determining whether expectations and assessments are aligned: sequential development, expert review, and document analyses.2-4 Sequential development is a structured method of alignment. In this logical but time-consuming method the learning expectations are developed first and then used to develop the curriculum. ...

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